Definujte zápatí – název prezentace nebo pracoviště1 Preclinical dentistry I. Class V. cavity preparation Characteristic ̶ Cervical defects Anatomical x Clinical crown Anatomical x clinical crown ̶ Anatomical crown - cementum- enamel junction ̶ Clinical crown – gingival border Anatomical X Clinical crown Cervical area ̶ Caries danger area – plaque accumulation ̶ Gingiva - possibility of its injury, bleeding, inflammation ̶ Flow of the sulcular liquid ̶ Specific ordering of the hard dental tissues ̶ Risk of perforation into dental pulp – thin layer of hard dental tissues Ordering of the dental tissues On the surface can be Enamel Cementum Dentin Risk of opening of the pulp chamber Types of defects ̶ Caries ̶ Erosion ̶ Abrasion Non carious lesions ̶ V shaped defects Dental caries 12 Abrasion Non correct technique of toothbrushing Hard toothbrush 13 Erosion 14 Erosion Acidic food, beverages,medicaments Gastric acid (reflux) Combination with abrasion V shaped defects ̶ Typical defects V – shape Abfraction (elastic deformation by occlusal loading, dentin is more elastic, enamel loses support – fracture of microscopic particles). Materials ̶ Amalgam ̶ Composite ̶ Glassionomer Definujte zápatí – název prezentace nebo pracoviště17 V.Class Amalgam ̶ Posterior area V.Class Amalgam - indication ̶ Posterior area ̶ Esp. Lower level of oral hygiene ̶ Patient does not want the aesthetic filling V.Class Amalgam - contraindication ̶ Frontal area ̶ Excellent level of oral hygiene ̶ Allergy ̶ Children (age15) Pregnant women Cavosurface margin - extention for prevention Gingivally: 0,5 below the gingival border Incisally below the maximum convexity Mesially and distally – till axial walls Total dephth: 0,75 – 1.25 mm. If on root surface -0,75 mm Gingival border Mesial snd distal border Incisal (occlusal)border Retention ̶ Box 0,75 – 1,25 mm deep, undercuts, coves (larger cavities) Excavation of carious dentin Round bur, slow rpm (3000) Excavator Finishing of cavity borders ̶ Fine diamond bur Filling ̶ Portion of amalgam are condensed using a condensor (stamen) and finished using a spatula or a carver. Class V. composit ➢ Aesthetic area Class V. composit indications ➢ Aesthetic area ̶ Cavities in enamel ̶ Excellent level of oral hygiene Class V. composit, contraindications ➢No dry operation fiels ➢Subgingival defects ➢ Malhygiena ➢Root surface caries Access ̶ Directly from vestibular or oral side ̶ Removal of undermined enamel ̶ Gingivoplasty and gingivectomy ̶ Temporary filling if necessary to push gingiva out Cavosurface margin and extention for prevention Gingival: supragingivally Occlusally: below the maximum convexity Mesially, distally: acc to size of the caries lesion Total dephth: appr. 1 mm. Excavation of carious dentin Round bur Excavator Cavity in enamel - bevel Completely Partly Retention (micromechnical) Enamel must be beveled (removal aprismatic enamel, good conditions for acid etching) Acid etching (35-37% phosphoric acid) 20-30 s in enamel, 10 s in dentin Washing Priming, bonding – disperse with air syringe, curing Placement of the composite material Matrices Anatomical form Good curing Class V. Glassionomer ̶ Indication: - Cavity out of enamel (root rurface caries) - Not optimal level of oral hygiene Class V. Glassionomer ̶ Contraindication: - Cavity out of enamel (root rurface caries) - Not optimal level of oral hygiene Glassionomer – benefits ➢Chemical binding to hard dental tissues ➢Realeasing fluoride ions ➢Thermal expansion similar to dentin ➢Acceptable aesthetics Glassionomer –disadvantages ➢ Vulnerable during setting ➢Nor strong mechanically Access ̶ Directly from vestibular or oral side ̶ Removal of undermined enamel ̶ Gingivoplasty and gingivectomy ̶ Temporary filling if necessary to push gingiva out Cavosurface margin and extention for prevention Preparation limited on caries lesion Retention ➢ Box ➢ Chemical Resistance No occlusal loading Excavation of carious dentin Round bur Excavator Finishing of the margin ̶ Smoothening using red coded diamond Filling ➢Conditioner 20 s ➢Washing off ➢Wet cavity ➢Filling material ➢Matrix ➢Varnish Matrices for glassionomer cement Definujte zápatí – název prezentace nebo pracoviště50 Class V. – Sandwich filling Base of galsionomer – replace of the lost dentin Thin layer of composite – replace of the lost enamel base of glassionomer Composite Connection Glassionomer – tooth: chemical Composite – tooth: micromechanical Composite – glassionomer Micromechanical. Access Into The Cavity ̶ Elimination od the undermined enamel - Burs or diamonds (pear), tapered fissure bur ̶ Separation of the gingiva– temporary filling guttapercha, fermit, clip, zinkoxidsulfate cement, cavit, provimat). ̶ Ablation of ingrown gingiva – surgical (scalpel, laser, high frequency current) V.Class Amalgam ̶ Posterior area Determination of cavity borders and extention for prevention We do not follow Black´s rules exactly! Gingival: axial dephth of 0,5 mm inside the DEJ. Extention of the preparation incisally, gingivally, mesially and distally untill the cavosurface margins are positioned in sound dental Gingival border Mesial snd distal border Incisal border Gingival border mesial and distal border Occlusal border Retention ̶ Box 0,75 – 1,25 mm deep, undercuts, coves (larger cavities) Resistance Elastic deformation during the biting Class five - composïte ➢ Aesthetic reasons Contraindication of composites ➢Bad hagiene ➢Subgingival cavities ➢Root caries (outside of enamel) Access Into The Cavity ̶ Elimination od the undermined enamel - Burs or diamonds (pear), tapered fissure bur ̶ Separation of the gingiva– temporary filling guttapercha, fermit, clip, zinkoxidsulfate cement, cavit, provimat). ̶ Ablation of ingrown gingiva – surgical (scalpel, laser, high frequency current) Composite must not be subgingival!!!! Determination of cavity borders cavosurface margin Cavity is limited on the caries defect only – no extention!!!! The depth usually 1 mm Retention ➢ Micromechanical retention Enamel: Retentive border – 1 – 2 mm wide and the angle 45° Cementum: only finishing with the fine diamond bur. Retention Retentive border: - removing of the aprismatic enamel – better condition for micromechanical retention - better aesthetics Retention Acid etching (phosphoric acid): 30 s dentin, 30 s enamel Rinsing (washing off) 30s Priming, bonding, light curing. Filling Spatula Matrix - Polyester strip, wooden wedges - Special cervical matrix Matrix Anatomical form Class five - glasionomer ̶ Cavity outside of enamel Properties ➢ Chemical fixation to tooth structure ➢ Fluoride release ➢ Favorable thermal expansion ➢ Aceptable aesthetics Class five - glasionomer ̶ Cavity outside of enamel Class five – glasionomer indications ̶ Cavity outside of enamel – root surface caries ̶ Other caries and defects ̶ When oral hygiene is not optimal Cavosurface margin Cavity is limited on the caries defect only – no extention!!!! The depth usually 1 mm Retention ➢ Box ➢ Chemical Finishing of cavity borders Fine diamond bur Matrices for glassionomers ̶ Cervical transparent matrices with the holder for lightcuring composites and glassionomers Preparation for glassionomer making filling ̶ Cavity is limited on carious lesion only ̶ Margins sholud be smoothen (no bevel) ̶ Conditioner (polyacrylic acid) -20 s ̶ Washing ̶ Placement of glassionomer (one bulk) ̶ Matrix (transparent or aluminium cervical ̶ matrix) Matrices for glassionomers ̶ Cervical foils Hawe adaptable metal cervical matrices have a specially treated aluminium surface and are suitable for all self-curing composites and glass ionomers. Class V. – Sandwich filling Base of galsionomer – replace of the lost dentin Thin layer of composite – replace of the lost enamel Base Composite Bond: GIC - Tooth Chemical Composite – Tooth Micromechanical Composite - GIC Micromechanical Sandwich filling 93 Management of subgingival cervical defects ̶ Retraction cord ̶ Liquid dam ̶ Rubberdam with retraction clamp ̶ Gingivectomy 94 lroubalikova@gmail.com95 Retraction cord lroubalikova@gmail.com96 Liquid dam